Citation Nr: 0111478
Decision Date: 04/19/01 Archive Date: 04/24/01
DOCKET NO. 00-14 040 ) DATE
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On appeal from the
Department of Veterans Affairs Regional Office in Togus,
Maine
THE ISSUES
1. Whether the veteran has presented new and material
evidence to reopen a claim for service connection for
essential hypertension.
2. Entitlement to service connection for organic heart
disease, to include hyperlipidemia and essential
hypertension.
REPRESENTATION
Appellant represented by: The American Legion
ATTORNEY FOR THE BOARD
D. Schechter, Associate Counsel
INTRODUCTION
The veteran had active service from November 1966 to December
1975
The appeal arises from the April 2000 rating decision of the
Department of Veterans Affairs (VA) Regional Office (RO) in
Togus, Maine, denying service connection for hypertension and
hyperlipidemia. The Board notes that the veteran was
previously denied service connection for borderline
hypertension in October 1996.
By this decision, infra, the Board has reopened the claim of
entitlement to service connection for essential hypertension.
The Board has then recharacterized the claims reviewed herein
as a single claim for service connection for organic heart
disease to include hyperlipidemia and essential hypertension,
to more appropriately reflect the nature and extent of the
disorder at issue.
FINDINGS OF FACT
1. Evidence received since the last final decision by the RO
in October 1996 is new and so significant that it must be
considered in order to fairly decide the veteran's claim for
service connection for essential hypertension on the merits.
2. Organic heart disease, to include hyperlipidemia and
essential hypertension, developed in service.
CONCLUSIONS OF LAW
1. New and material evidence has been received since the RO
decision in October 1996 denying service connection for
essential hypertension; the claim is reopened. 38 U.S.C.A.
§§ 5108, 7104 (West 1991); 38 C.F.R. § 3.156 (a) (2000).
2. Organic heart disease, to include hyperlipidemia and
essential hypertension, was incurred in service. 38 U.S.C.A.
§§ 1110, 1131, 5107 (West 1991& Supp 2000); 38 C.F.R.
§ 3.303(d) (2000).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
1. Duties Under the VCAA
As a preliminary matter, the VA has a duty to assist the
appellant in obtaining evidence necessary to substantiate the
claim. Veterans Claims Assistance Act of 2000, Pub. L. No.
106-475, § 3(a), 114 Stat. 2096, 2097-98 (2000) (to be
codified at 38 U.S.C. § 5103A). The Board is satisfied that
the duty has been satisfied in this case, particularly in
light of the Board's grant of the benefits sought on appeal.
2. Whether New and Material Evidence has been Presented
to Reopen a Claim for Service Connection for
Essential Hypertension
38 C.F.R. § 3.156(a) provides, in pertinent part, that in
order to reopen a claim for service connection, there must be
added to the record new and material evidence which bears
directly and substantially upon the specific matter under
consideration, which is neither cumulative nor redundant, and
which by itself or in connection with evidence previously
assembled is so significant that it must be considered in
order to fairly decide the merits of the claim. The United
States Court of Appeals for Veterans Claims (Court) has held
that once a denial of service connection has become final the
claim cannot subsequently be reopened unless new and material
evidence has been presented. The Board must perform a two-
step analysis when the veteran seeks to reopen a claim based
on new evidence. First, the Board must determine whether the
evidence is "new and material." Second, if the Board
determines that the claimant has produced new and material
evidence, the claim is reopened and the Board must evaluate
the merits of the veteran's claim in light of all the
evidence, both old and new. Manio v. Derwinski, 1 Vet. App.
140, 145 (1991). The language of 3.156(a) itself is to be
used to determine if evidence submitted since the last prior
final denial is new and material, so as to warrant reopening
the claim. See Hodge v. West, 155 F. 3d. 1356 (1998).
A blood pressure reading in a service clinical record in
April 1974 was 142/88, and a reading in June 1974 was 140/90.
A November 1974 service medical record included an assessment
of hypercholesterolemia. Cholesterol was 255 and
Triglycerides were 205.
A January 1975 service medical record noted that
triglycerides and cholesterol were elevated. Blood pressure
readings were then 136/88 in the right arm and 130/80 in the
left arm. The veteran complained of a feeling of bad
circulation and recurrent paresthesias over the entire body.
On service separation examination in December 1975 the
veteran had a blood pressure reading of 138/92.
The claims folder contains an December 1992 clinical record
from M. C. Lemieux, M.D., a private physician, of initial
evaluation of the veteran for treatment of heart disease.
The physician noted, in pertinent part, a history of coronary
artery disease status post percutaneous transluminal
angioplasty times three, most recently three years prior;
hypertension; and hypercholesterolemia. The veteran was
seeking coronary care based on a recent elevated blood
pressure reading. Blood pressure on examination was 152/98.
Coronary findings were otherwise unremarkable. The physician
assessed, in pertinent part, coronary artery disease, stable
on current regimen, with the exception that an increased
level of Cardizem CD was prescribed for hypertension control.
The claims folder contains further records of treatment by
Dr. Lemieux between 1992 and 1995. In an October 1995
letter, the physician noted that the veteran's cholesterol
had been relatively stable, and blood-pressure was well-
controlled. Medication then included Lopressor, Lopid,
Mevacor, Ativan, Cardizem CD, and Aspirin.
Medical evidence added to the claims folder subsequent to the
last final decision by the RO in October 1996 denying service
connection for hypertension, includes VA and private clinical
records of treatment for heart disease, private medical
opinions regarding the etiology of the veteran's heart
disease, and an April 2000 VA medical examination report.
The VA and private medical treatment records only note
treatment for heart disease, without speaking to the origin
and onset of the disorder.
In a November 1999 letter, R. J. Ulin, M.D., a private
physician, informed that the veteran was currently a patient
of his with coronary artery disease. The physician noted the
veteran's history of heart disease with multiple prior
angioplasties. The physician also reported that he had
reviewed a service clinical record from June 1974, wherein
hyperlipidemia, type IV, was assessed, and a blood pressure
reading was 140/90. The physician opined that the veteran's
coronary artery disease was likely to have been a direct
result of the veteran's ongoing problems with hypertension
and hyperlipidemia, which were both diagnosed in June 1974.
This November 1999 letter by Dr. Ulin constitutes new and
material evidence which is so significant that it must be
considered together with all the evidence of record in order
to fairly adjudicate the veteran's claim for service
connection for essential hypertension on the merits.
Accordingly, reopening of the veteran's claim of entitlement
to service connection for essential hypertension is
warranted.
3. Entitlement to Service Connection for Organic Heart
Disease, to Include Hyperlipidemia and Essential Hypertension
Continuing with a review of the medical record, the Board
notes that the claims folder contains a record of VA heart
examination in April 2000. The veteran's cardiac history was
noted, including a history of four angioplasties, as well as
hypertension, hyperlipidemia, and past intermittent angina,
with medication including Diltiazem, Lipitor, Lisinopril,
Terazosin, aspirin, and nitroglycerin. Ongoing
symptomatology, care, and treatment for coronary artery
disease were noted. Regarding the veteran's history of
hypertension, the veteran reported that he was informed of
transient hypertension in 1974 and 1975. The examiner noted
that two blood pressure readings in 1974 were 142/88 and
120/78, and commented that by standards set by the American
Heart Association those readings were not considered
hypertension. The examiner further noted that blood pressure
readings in 1975 of 136/88 and 130/80 were normal. The
examiner further noted that current blood pressure was being
controlled with Diltiazem, with current blood pressure
readings of 138/88, 142/86, and 140/90 all being within
normal limits. The examiner opined that it was unlikely that
the blood pressure readings noted in 1974 and 1975 were
related to his hypertension requiring medication in 1992.
The claims folder also contains an additional letter from Dr.
Ulin, dated in April 2000. In the letter, Dr. Ulin noted the
veteran's long history of hypertension and hyperlipidemia
beginning in service in June 1974. The physician informed
that it was established medical knowledge, based on multiple
large-scale observation studies, that hypertension and
hyperlipidemia were risk factors of coronary artery disease.
The Board notes that in order to establish service connection
for a disability, there must be evidence that establishes
that such disability either began in or was aggravated by
service. 38 U.S.C.A. § 1110, 1131 (1991). Service
connection may be granted for any disease diagnosed after
discharge from service, when all the evidence, including that
pertinent to service, establishes that the disease was
incurred in service. 38 C.F.R. § 3.303(d) (2000). A
determination of service connection requires a finding of the
existence of a current disability and a determination of a
relationship between that disability and an injury or disease
incurred in service. Watson v. Brown, 4 Vet.App. 309, 314
(1993).
During service the veteran was found to have hyperlipidemia
and elevated blood pressure readings including on service
separation examination in December 1975. The elevated blood
pressure reading on the service discharge examination is
significant, because it was not followed by intervening
normal blood pressure readings prior to 1992. In 1992 the
veteran had organic heart disease including essential
hypertension and hypercholesterolemia (also known as
hyperlipidemia). In more recent years the veteran has been
treated for heart disease, including with multiple balloon
angioplasties and medication to control this disorder. On an
evidentiary basis, and based on favorable medical opinions by
Dr. Ulin in November 1999 and April 2000, the Board concludes
that hyperlipidemia and essential hypertension were present
in service and ultimately manifested themselves as organic
heart disease with essential hypertension and
hypercholesterolemia.
The Board notes the presence of both favorable and
unfavorable medical opinions in the record. However, the
Board notes that the unfavorable VA medical opinion in April
2000 appears not to have been based on the entire evidentiary
record, with that opinion failing to consider favorable
service medical evidence, including an elevated blood
pressure reading recorded on the veteran's December 1975
service separation examination, and inservice assessments of
hyperlipidemia. Accordingly, the Board has placed greater
probative value on Dr. Ulin's opinions.
ORDER
1. The claim of entitlement to service connection for
essential hypertension is reopened.
2. Service connection for organic heart disease, to include
hyperlipidemia and essential hypertension, is granted.
BRUCE E. HYMAN
Member, Board of Veterans' Appeals